Acupuncture, Herbs and Nutrients for Knee Pain

compiled by John G. Connor, M.Ac., L.Ac. and Barbara Connor, M.Ac., L.Ac.

Barbara & I would like to share with you today 13 studies on the beneficial effects of acupuncture on knee pain as well as 8 studies on the beneficial effects of various herbs and nutrients on knee pain.  We hope you find this information useful in your quest for optimal knee health.

Studies on the Beneficial Effects of Acupuncture on Knee Pain

  • Evaluation of the Effectiveness of Acupuncture in the Treatment of Knee Osteoarthritis: A Case Study The present case study included two patients with clinical signs of osteoarthritis and diagnosis of medial pain, as defined by the Heidelberg Model of TCM. Over 6 weeks, those patients were treated with acupuncture, with a frequency of one session a week. The sessions lasted for thirty minutes and were based on the needling of 4 local acupoints. Before and after each session, pain and mobility assessments were performed. Results: The results were positive, with significant reduction of pain and increased knee joint flexion amplitude and mobility. Conclusion: Acupuncture was effective as an alternative or complementary treatment of knee osteoarthritis, with high levels of improvement within a modest intervention period. (Teixeira et al 2018)   
  • Drug-Free Interventions to Reduce Pain or Opioid Consumption After Total Knee Arthroplasty: A Systematic Review and Meta-analysis. In this meta-analysis, electrotherapy and acupuncture after total knee arthroplasty were associated with reduced and delayed opioid consumption. (Tedesco et al 2017)
  • Electro-Acupuncture (EA) is Beneficial for Knee Osteoarthritis (KOA): The Evidence from Meta-Analysis of Randomized Controlled Trials.  Conclusively, the results indicate that electro-acupuncture is a great opportunity to remarkably alleviate the pain and improve the physical function of knee osteoarthritis (KOA) patients with a low risk of adverse reaction. Therefore, more high quality RCTs with rigorous methods of design, measurement and evaluation are needed to confirm the long-term effects of electro-acupuncture for knee osteoarthritis. (Chen et al 2017)
  • Warm-needling moxibustion for knee osteoarthritis:a randomized controlled trial Fifty cases of knee osteoarthritis were randomly divided into an observation group (25 cases) and a control group (21 cases), but 4 cases lost contact. Warm-needling moxibustion could relieve pain, improve function and muscle balance, strengthen extensor and flexor muscle power, especially extensor, which has superior clinical efficacy. (Wang et al 2017)
  • Therapeutic effect observation of chronic knee joint pain assisted with the central-square needling technique of the thumb-tack needles. At the end of follow-up visit, Lequesne index scores were all improved as compared with those before treatment in the two groups (both P<0.05) and the improvements were similar between the two groups (P>0.05) The acupuncture scheme in assistance with the central-square needling technique of thumb-tack needles obviously relieves chronic knee joint pain, much better sustains the analgesic effects of acupuncture and improves patient compliance. (Yang et al 2017)
  • Influence of acupuncture in treatment of knee osteoarthritis and cartilage reparing. These results indicate that acupuncture represents certain clinical effect on knee osteoarthritis  which is superior compared with physiotherapy, and hint the possible roles of acupuncture in promoting cartilage  repairing. (Zhang et al 2016)
  • Acupuncture for postoperative pain, a literature review. Five controlled trials and two systematic reviews were selected.  In knee replacement, acupuncture reduced pain by 2% and analgesic consumption by 42%. Acupuncture may be useful to manage postoperative pain, but more controlled studies are required. (Fuentealba Cargill & Biagini Alarcon 2016)
  • Acupuncture is Effective for Chronic Knee Pain: A Reanalysis of the Australian Acupuncture Trial.  Compared with conventional care, acupuncture treatment was found to be moderately effective for chronic knee pain in patients aged 50 years and older. (Fan et al 2016)
  • Effective chronic low back pain and knee pain treatment with acupuncture in geriatric patients. This study showed mean back pain scores (8.8696 ± 1.546) and mean knee pain scores (9.1304 ± 1.4239) of patients were reduced significantly to 2.1739 ± 1.466 and 1.455 ± 0.7; p< 0.001 respectively after the acupuncture treatment. These are important results as they give rationale to use acupuncture treatment widely in chronic low back pain and knee pain in the geriatric group of patients to reduce the side effects of polypharmacy in elderly. (Cevik et al 2015)
  • The combined therapy of acupuncture and moxibustion achieves the safe and effective therapeutic effect with less adverse reactions in the treatment of knee osteoarthritis. The immediate effect in the combined therapy group is not so obvious as compared with the western medication, but the long-term efficacy is remarkably superior to western medication. (Xu et al 2013)
  • Acupuncture provided significantly better relief from knee osteoarthritis pain and a larger improvement in function than sham acupuncture, standard care treatment, or waiting for further treatment. (Cao et al 2012)
  • Acupuncture that meets criteria for adequate treatment is significantly superior to sham acupuncture and to no additional intervention in improving pain and function in patients with chronic knee pain. Due to the heterogeneity in the results, however, further research is required to confirm these findings and provide more information on long-term effects. (White et al 2007)
  • A randomized trial of acupuncture as an adjunctive therapy in osteoarthritis of the knee. Seventy-three patients with symptomatic OA of the knee were randomly assigned to treatment (acupuncture) or standard care (control). Significant differences on total WOMAC [Western Ontario and McMaster Universities Osteoarthritis Index: subindexes for pain, stiffness, and physical function] Scale were seen at 4 and 8 weeks. There appears to be a slight decline in effect at 4 weeks after cessation of treatment (12 weeks after first treatment). No adverse effects of acupuncture were reported.These data suggest that  acupuncture is an effective and safe adjunctive therapy to conventional care for patients with osteoarthritis of the knee. (Berman et al 1999)

Studies on the Beneficial Effects of Various Herbs and Nutrients on Knee Pain

    • Ajuga decumbens extract
    • Avocado soybean unsaponifiables
    • Boswellia serrata
    • Chondroitin sulfate
    • Collagen hydrolysate
    • Curcuma longa rhizome
    • Devil’s claw (Harpagophytum procumbens)
    • Glucosamine and chondroitin
    • Green-lipped mussel extract
    • Hydrolyzed Collagen, Chondroitin Sulfate and Glucosamine
    • L-carnitine
    • Methylsulfonylmethane (MSM)
    • Passion fruit peel extract
    • Pycnogenol
    • Terminalia chebula fruit
    • Undenatured type II collagen
  • A Placebo-Controlled Double-Blind Study Demonstrates the Clinical Efficacy of a Novel Herbal Formulation for Relieving Joint Discomfort in Human Subjects with Osteoarthritis of Knee.  At the end of the trial period, LI73014F2 ( a novel composition prepared from extracts of Terminalia chebula fruit, Curcuma longa rhizome, and Boswellia serrata gum resin with synergistic benefit in 5-Lipoxygenase (5-LOX) inhibition) conferred significant pain relief, improved physical function, and quality of life in osteoarthritis patients. In conclusion, preclinical and clinical data together strongly suggest that the herbal formulation LI73014F2 is a safe and effective intervention for management of joint discomfort, demonstrating efficacy as early as 14 days. (Karlapudi et al 2018)
  • Efficacy of Chondroitin Sulfate for Painful Knee Osteoarthritis: A One-Year, Randomized, Double-Blind, Multicenter Clinical Study in Japan. Serum level of cartilage oligomeric matrix protein and hyaluronic acid were also determined. In the subgroup with severe symptoms (Lequesne’s index ≥8), the chondroitin sulfate dose of 1560 mg/d improved pain faster after 6 and 9 months’ therapy. However, no dose-related effects were found on cartilage oligomeric matrix protein or hyaluronic acid levels. Chondroitin sulfate also had good tolerability. We conclude that chondroitin sulfate is useful for pain control in knee osteoarthritis. (Morita et al 2018)
  • Effectiveness of a Dietary Supplement Containing Hydrolyzed Collagen, Chondroitin Sulfate, and Glucosamine in Pain Reduction and Functional Capacity in Osteoarthritis Patients. The total reduction in the Lequesne Functional Index was 6.30 ± 4.08 points after 6 months (p < .0001), with significant reductions in all subindexes of the scale. A similar pattern was found for the WOMAC index, with an overall reduction of 22.49 ± 14.03 points after 6 months (p < .0001) and significant reductions in all subindexes. No major adverse events were noted during the treatment. This exploratory study shows that treatment with the dietary supplement significantly reduces pain and improves locomotor function in patients with OA of the knee and/or hip. (Puigdellivol let al 2018)
  • Dietary supplements for treating osteoarthritis: a systematic review and meta-analysis. Of 20 supplements investigated in 69 eligible studies, 7 (collagen hydrolysate, passion fruit peel extract, Curcuma longa extract, Boswellia serrata extract, curcumin, pycnogenol and L-carnitine) demonstrated large (effect size >0.80) and clinically important effects for pain reduction at short term. Another six (undenatured type II collagen, avocado soybean unsaponifiables, methylsulfonylmethane, diacerein, glucosamine and chondroitin) revealed statistically significant improvements on pain, but were of unclear clinical importance. Only green-lipped mussel extract and undenatured type II collagen had clinically important effects on pain at medium term. The overall analysis including all trials showed that supplements provided moderate and clinically meaningful treatment effects on pain and function in patients with hand, hip or knee osteoarthritis at short term, although the quality of evidence was very low. (Liu et al 2018)
  • Evaluation of the efficacy of Ajuga decumbens extract supplement in individuals with knee discomfort associated with physical activity: A randomized, double-blind, placebo-controlled study. In conclusion, these observations suggest that the administration of an Ajuga decumbens extract-containing diet is safe and improves joint function (flexion and stiffness) and general activity in subjects with mild knee discomfort. Therefore, Ajuga decumbens extract could be a promising candidate as a functional food that is beneficial to joint health. (Sawada et al 2017)
  • Benefits of antioxidant supplements for knee osteoarthritis: rationale and reality. This review shows that there is some evidence for benefits of antioxidant supplements in pain relief and function in knee osteoarthritis. These supplements with the most evidence include curcumin, avocado-soya bean unsaponifiables, Boswellia and several preparations used in Ayurvedic and Chinese medicine. These should be tested further and used, at least, to decrease the use of NSAIDs which have more adverse effects. Ancient medicine should be tested as such rather than proprietary products made from them. It should be assessed whether diet with turmeric and black pepper results in sufficient levels of serum curcumin. Promotion of dietary habits may be more economical and of longer term benefit than the development of products made from extracts used in ancient medicine. (Grover & Samson 2016)
  • Treatment of patients with arthrosis of hip or knee with an aqueous extract of devil’s claw (Harpagophytum procumbens DC.). The results of the study revealed a strong reduction of pain and the symptoms of osteoarthritis. There was a relevant improvement of each WOMAC subscale as well as of the total WOMAC index: 23.8% for the pain subscale, 22.2% for the stiffness subscale and 23.1% for the physical function subscale. The WOMAC total score was reduced by 22.9%. VAS pain scores were decreased by 25.8% for actual pain, 25.2% for average pain, 22.6% for worst pain and 24.5% for the total pain score. The physicians reported a continuous improvement in typical clinical findings such as 45.5% for pain on palpation, 35% for limitation of mobility and 25.4% for joint crepitus. Only two cases of possible adverse drug reactions were reported (dyspeptic complaints and a sensation of fullness). Although this was an open clinical study, the results suggest that this Devil’s claw extract has a clinically beneficial effect in the treatment of arthrosis of the hip or knee. (Wegener & Lupke 2003)

  • Efficacy and tolerability of Boswellia serrata extract in treatment of osteoarthritis of knee–a randomized double blind placebo controlled trial.  All patients receiving drug treatment reported decrease in knee pain, increased knee flexion and increased walking distance. The frequency of swelling in the knee joint was decreased. Radiologically there was no change. The observed differences between drug treated and placebo being statistically significant, are clinically relevant. Boswellia serrata extract was well tolerated by the subjects except for minor gastrointestinal ADRs. Boswellia serrata extract is recommended in the patients of osteoarthritis of the knee with possible therapeutic use in other arthritis. (Kimmatkar et al 2003)
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Compassionate Acupuncture and Healing Arts, providing craniosacral acupuncture, herbal and nutritional medicine in Durham, North Carolina. Phone number 919-309-7753.

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Acupuncture, Herbs and Foods for Diabetes

by John & Barbara Connor, M.Ac., L.Ac.

Barbara and I would like to share with you today studies on some of the natural ways you can maintain healthy blood sugar levels. These include studies on foods that are beneficial as well as harmful for type 2 diabetes, as well as studies on specific herbs and nutrients for diabetes and studies showing how acupuncture can be beneficial in treating diabetes. We hope you find this article helpful.

Table of Contents

  • Introduction
  • Foods to Eat that are Beneficial in Reducing the Risk of Type 2 Diabetes
  • Food to Avoid in Order to Reduce the Risk of Type 2 Diabetes
  • Studies Relating to Dietary Considerations in Insulin Resistance and Diabetes
  • Beneficial Herbs, Nutrients and Foods for Insulin Resistance and Diabetes
  • Studies on Beneficial Herbs, Nutrients and Foods for Insulin Resistance and Diabetes
  • Studies on the Beneficial Effects of Acupuncture on Diabetes
  • Blood Markers in Insulin Resistance and Diabetes

Introduction

In order to ensure normal body function, the human body is dependent on a tight control of its blood glucose levels. The pancreas plays a key role in this by secreting the blood sugar-lowering hormone insulin and its opponent glucagon. Disturbances in the interplay of the hormones and peptides involved may lead to metabolic disorders such as type 2 diabetes mellitus (T2DM). (Roder et al 2016)

Insulin resistance is a primary defect that is a characteristic feature of type 2 diabetes. The state of insulin resistance leads to increased insulin secretion by pancreatic β-cells and compensatory hyperinsulinemia. As long as compensatory hyperinsulinemia is sufficient to overcome the insulin resistance, fasting glycemia and glucose tolerance remain relatively normal. In patients predestined to progress to type 2 diabetes, β-cell compensation efficiency declines and relative insulin insufficiency develops, leading to impaired glucose tolerance and, eventually, type 2 diabetes. Consequently, type 2 diabetes results from the progressive failure of pancreatic β-cells in a setting of chronic insulin resistance. (Park et al 2013)

Reactive oxygen species (ROS) play an important role in insulin resistance and pancreatic β-cell dysfunction, a highly prevalent condition implicated in the development of type 2 diabetes. Under a diabetic condition, chronic hyperglycemia may induce large amounts of ROS that are responsible for the progressive dysfunction of β-cells, worsening insulin resistance and further promoting relative insulin deficiency ROS. β-Cells, in particular, are particularly sensitive to ROS because they are low in free-radical quenching (antioxidant) enzymes such as catalase, glutathione peroxidase, and superoxide dismutase. (Park et al 2013)

Prior studies have exhibited that the prevalence of obesity and T2DM in people with coronary heart disease (CHD) exceeds that of the general population. Different factors have been involved in the progression of T2DM and CHD such as little glycemic control and dyslipidemia. In addition, low-grade inflammation resulting from free radicals and reactive oxygen species (ROS) may help to the expansion of metabolic complexity in diabetic vascular disease. (Raygan et al 2016)

There is no argument that improving mean level of glycemic control, assessed by glycated hemoglobin (HbA1c), reduces the risk of microvascular complications and cardiovascular disease (CVD) events in patients with T2D. Chronic sustained hyperglycemia has been shown to exert deleterious effects on the β cells and the vascular endothelium. (Huang et al 2017)

Diabetes mellitus (DM) is associated with a wide range of microvascular complications including diabetic retinopathy (DR). One of the main risk factors associated with development of DR is poorly controlled blood sugar as assessed by glycated hemoglobin levels (HbA1c)—the higher the HbA1c, the greater the risk of developing retinopathy. (Pusparahah et al 2016)

Studies have found that peripheral neuropathy (which includes any disorder of the peripheral nervous system, including polyneuropathy, polyradiculopathies, and mononeuropathy) occurs in up to half of the population with diabetes. (Dy et al 2017 )

Progression of diabetes, and especially poor glycemic control, leads to numerous potentially life threatening complications. Almost half of the adults with chronic kidney disease are derived from diabetic population. Likewise, 9.8% of diabetics have experienced heart attack, 9.1% suffer from coronary artery disease (CAD), 7.9% have congestive heart failure, 6.6% have stroke while more than a quarter of them 27.8% suffer from chronic kidney disease, almost a quarter 22.9% have foot problems and last but not least 18.9% have eye damage. (Trikkalinou et al 2017)

Preexisting diabetes in cancer patients at the time of diagnosis was associated with a hazard ratio of 1.41 for the risk of all-cause mortality compared with individuals without diabetes when pooled across 23 studies of various types of cancer. While the association of diabetes and site-specific mortality risk reached statistical significance only for cancers of the endometrium, breast, and colorectum, diabetes appeared to be associated with some additional mortality risk for all types of cancer. (Barone et al 2011)

Foods to Eat that are Beneficial in Reducing the Risk of Type 2 Diabetes:

  • Beans/legumes
  • Dairy
  • Dairy products
  • Dietary fiber
  • Dried fruits
  • Fish
  • Fruits
  • Low glycemic index foods
  • Low glycemic load dietary pattern combined with a traditional Mediterranean diet
  • Nuts
  • Plant protein (decreases the risk of type 2 diabetes in females)
  • Polyunsaturated fats
  • Seafood omega-3s
  • Seeds
  • Soy
  • Vegetables
  • Whole grains
  • Yogurt

Foods to Avoid in Order to Reduce the Risk of Type 2 Diabetes

  • High glycemic index and high glycemic load foods
  • Nonnutritive sweeteners
  • Processed meats
  • Red meat and processed meat
  • Sugar-sweetened beverages
  • Total protein and animal protein
  • Trans-fats
  • Unprocessed red meats

Studies Relating to Dietary Considerations in Insulin Resistance and Diabetes

The results of this meta-analysis show that total protein and animal protein could increase the risk of type 2 diabetes mellitus (T2DM) in both males and females, and plant protein decreases the risk of T2DM in females. The association between high-protein food types and T2DM are also different. Red meat and processed meat are risk factors of T2DM, and soy, dairy and dairy products are the protective factors of T2DM. Egg and fish intake are not associated with a decreased risk of T2DM. This research indicates the type of dietary protein and food sources of protein that should be considered for the prevention of diabetes. (Tian et al 2017)

Only 8 identified dietary factors had probable or convincing evidence for causal effects on diabetes, including protective effects of nuts/seeds, whole grains, yogurt, and dietary fiber, and harms of unprocessed red meats, processed meats, sugar-sweetened beverages (SSBs), and glycemic load. SSBs and glycemic load were most frequently studied. Processed meats had the strongest estimated effect, with 1.51 relative risk (RR) per daily serving; other foods had more modest effects, such as 0.82 and 0.88 RR per daily serving of yogurt and whole grains, respectively. SSBs had a small but statistically significant etiologic effect on body weight, with smaller effects in normal weight (per daily serving, 0.10 kg/m2 increase in BMI) vs. overweight or obese (0.23 kg/m2) individuals. (Mischa et al 2017)

Undoubtedly, the specific composition of nuts and dried fruits means that they can be used to efficiently counteract metabolic diseases such as type 2 diabetes. Their unique profile of macronutrients, micronutrients and other bioactive compounds may explain the beneficial effects observed in clinical and epidemiological studies. However, the exact mechanisms by which they modulate glucose and insulin metabolism and influence T2D have yet to be fully discovered. (Hernandez-Alonso et al 2017)

Restricted carbohydrate (RC) diet (43-49% carbohydrate and 36-40% fats) diet in overweight T2D with  coronary heart disease (CHD) had beneficial effects on fasting plasma glucose (FPG), hs-CRP,  total antioxidant capacity (TAC), and glutathione (GSH) values. This study demonstrated that compared with a high-carbohydrate diet, adherence to a RC diet for 8 weeks decreased serum hs-CRP and increased plasma TAC and GSH concentrations. (Raygan et al 2016)

Consumption of most carbohydrates increases blood glucose and blood insulin, but to varying extents, depending on carbohydrate type and processing, amount consumed, and presence of other nutrients. These variations are captured by the glycemic index (GI), which ranks carbohydrate foods according to their ability to raise blood glucose levels. High GI foods, like white bread, are rapidly digested and cause a rapid peak in blood glucose. Low GI foods like pulses and pasta, are digested more slowly, prompting a more gradual rise in blood glucose. Glycemic load (GL), the product of a food’s GI and its available carbohydrate content, was introduced to incorporate the effect of the total amount of carbohydrate consumed: it is a measure of total glycemic effect, and is hence an indicator of the insulin demand of the diet. (Sieri et al 2017)

High glycemic index was associated with increased risk of colon and bladder cancer. High glycemic load was associated with: increased risk of colon cancer; increased risk of diabetes-related cancers; and decreased risk of rectal cancer. (Sieri et al 2017)

Glycemic load measures carbohydrate absorption in relation to insulin demand — in other words, it measures how quickly a food’s carbohydrates are turned into sugars by the body (glycemic index) in relation to the amount of carbohydrates per serving of that food. Some examples of foods with a high glycemic load are white breads, white rice, brown rice pasta, white rice cakes, popcorn and rice milk.

The results of one study showed that a high adherence to the Mediterranean diet was inversely associated with T2DM risk (OR = 0.88, CI: 0.77–0.99, p trend = 0.021) while combining it with low glycemic load (GL) the association became stronger (OR = 0.82, CI: 0.71–0.95). These results suggest that a low GL combined with a traditional Mediterranean diet conveys 18% protection against the occurrence of T2DM suggesting that even within an overall healthy diet there may be benefits of lowering the dietary GL. (Augustin et al 2015)

The results of this study suggest that for patients with diabetes low-glycemic index diets achieve a more beneficial effect on glycemic control than that of high-glycemic index foods diets. (Wang et al 2015)

Dairy products, legumes, and fruits were found to have a low-glycemic index. Breads, breakfast cereals, and rice, including whole grain, were available in both high and low GI versions. (Atkinson et al 2008)

This meta-analysis provides high-level evidence that diets with a high GI, high GL, or both, independently of known confounders, including fiber intake, increase the risk of chronic lifestyle-related diseases. The effect was modest overall (GI RR = 1.14; GL RR = 1.09) but more pronounced for type 2 diabetes (GI RR = 1.40; GL RR = 1.27), heart disease (GI RR = 1.25), and gallbladder disease (GI RR = 1.26; GL RR = 1.41). Overall, the GI had a more powerful effect than did the GL (the product of carbohydrate and GI), with more positive associations between GI and chronic disease risk, and associations of greater magnitude, which suggests that, irrespective of the level of carbohydrate intake, the GI of contributing carbohydrate foods is important. (Barclay et al 2008)

The results of this study also extend previous meta-analyses that showed higher risks of type 2 diabetes and hypertension with regular consumption of nonnutritive sweeteners, such as aspartame, sucralose and stevioside. (Azad et al 2017)

Beneficial Herbs, Nutrients and Foods for Insulin Resistance and Diabetes

  • Bitter gourd
  • Curcumin
  • Fenugreek
  • Fenugreek and onion
  • Flavonoids
  • Galega officinalis
  • Ginseng
  • Gymnena sylvestre
  • Jade Spring Pills
  • Mucuna pruriens
  • Mulberry leaf, fenugreek seed and American ginseng
  • Olive oil
  • Pterocarpus marsupiam
  • Salacia reticulata
  • Vitamin D

Studies on Beneficial Herbs, Nutrients and Foods for Insulin Resistance and Diabetes

Bitter gourd (Momordica charantia) increases insulin secretion of the pancreas, decreases intestinal glucose uptake, and increases uptake and utilization of glucose in peripheral tissues. Although human studies with type 2 diabetics are weak in their design and/or results, some of the studies do indicate anti-diabetic effects in patients and safety for bitter gourd treatment in humans. (Habicht et al 2014)

Bitter gourd (Momordica charantia) – Although evidence suggests possible beneficial effects of extracts of bitter melon and its active compounds in the prevention and control of diabetes, future clinical studies are needed to confirm this. (Ota & Ulrih 2017)

Curcumin has shown the confident results to be effective for the treatment of impaired glucose tolerance. Fenugreek and flaxseed may also be effective, but due to low quality of these studies the results must be interpreted with caution. (Demmers et al 2017)

Fenugreek  Although results from clinical trials support beneficial effects of fenugreek seeds on glycemic control in persons with diabetes, trials with better methodology quality and well characterized preparation of sufficient dose are needed to provide more conclusive evidence. With its hypoglycemic and antidyslipidemic effects, fenugreek represents an attractive new candidate for treatment of type 2 diabetes, obesity, and dyslipidemia, the key components of metabolic syndrome. (Ota & Ulrih 2017)

Fenugreek and onion – This study documented the hypoglycemic and insulinotropic effects of dietary fenugreek and onion, which were associated with countering of metabolic abnormalities and pancreatic pathology. It may be strategic to derive maximum nutraceutical antidiabetic benefits from these functional food ingredients by consuming them together. (Pradeep & Srinivasan 2017)

Flavonoids – There is growing evidence based on in vitro and animal research that polyphenols in general, and in particular the flavonoids, a class of polyphenols, can improve glucose homeostasis and enhance insulin secretion and sensitivity. Our observations support previous experimental evidence of a possible beneficial relationship between increased flavonol intake and risk of T2D. (Jacques et al 2013) *Examples of flavonoid compounds are quercetin, EGCG and anthocyanins

Galega officinalis (Goat’s Rue, galega) – Together with its established hypoglycaemic effects, galega has a novel weight reducing action that, in normal mice, is largely independent of a reduction in food intake. (Palit et al 1999)

Ginseng modestly yet significantly improved fasting blood glucose in people with and without diabetes. (Shishtar et al 2014)

Gymnema sylvestre (gurmar) – Several studies have reported antidiabetic effects and sugar inactivation properties of gurmar. (Ota & Ulrih 2017)

Jade Spring Pills – According to a clinical evaluation reported by Fegn et al in The Journal of the Shangdong College of TCM 1994; 18(6): 376-377 the Chinese herb formula for diabetes, Jade Spring Pills, used for the control group, was reported to be effective in reducing blood sugar for 79% of the cases treated. (Fegn et al 1994)

Mucuna pruriens – The study clearly supports the traditional use of Mucuna pruriens for the treatment of diabetes and indicates that the plant could be a good source of potent antidiabetic drug. (Majekodumi et al 2011)

Mucuna pruriens – This study shows that Mucuna pruriens has an anti-hyperglycemic action and it could be a source of hypoglycemic compounds. (Bhaskar et al 2008)

Mulberry leaf, fenugreek seed and American ginseng – Botanicals have been used in traditional Chinese medicine (TCM) for thousands of years to treat T2DM, which is named “wasting-thirst” in TCM. A novel botanical formula containing standardized extracts of mulberry leaf, fenugreek seed and American ginseng at a ratio of 1:1.3:3.4 prevented the development of insulin resistance, impaired glucose tolerance and T2DM. Given the rising need for effective non-drug targeting of insulin resistance and progression to T2DM, complementary and alternative nutritional strategies without intolerable side effects could have meaningful impact on metabolic health and diabetes risks. (Kan et al 2017)

Olive oil – The present systematic review and meta-analysis provides evidence of favorable effects of olive oil on type 2 diabetes risk and parameters of glycemic control. (Schwingshackl et al 2017) PMID: 28394365

Pterocarpus marsupium – This study justifies the traditional claim and provides a rationale for the use of Pterocarpus marsupium to treat diabetes mellitus. The antidiabetic activity of Pterocarpus marsupium can be enhanced by extracting the heartwood by non conventional method of ultrasound-assisted extraction. (Devgan et al 2013)

Salacia reticulata – Clinically significant reductions of HbA1C and plasma Insulin are reported with treatment of 6 weeks to 3 months. One clinical trial reported significant reduction of weight and BMI when Salacia is used in combination with vitamin D. Salacia reticulata effectively improves insulin resistance, glucose metabolism and reduces obesity. A larger evidence base is required from well-planned studies to confirm its efficacy and safety. (Medagama AB 2015)

Vitamin D – The present study shows that oral Vitamin D supplementation of 60,000 IU/week for 8 weeks significantly improves vascular functions and reduces oxidative stress in type 2 diabetic patients with Vitamin D deficiency. (Anandabaskar et al 2017)

Studies on the Beneficial Effects of Acupuncture on Diabetes

Diabetes is categorized in Chinese Medicine into various patterns according to the signs and symptoms of each individual case.  Diabetes is usually attributed to Deficient Kidney Essence.  Chinese Medical patterns describing diabetes include:  Deficiency of Kidney Yin, Yin Deficiency with Internal Heat, Deficiency of Spleen Yin, Deficiency of both Yin and Qi, Excessive Heat in the Lung and Stomach and Hyperactivity of Stomach Fire. The following studies show the benefits of acupuncture in diabetes and related blood sugar issues.

  • Forty type 2 diabetes mellitus (T2DM) patients were recruited and randomized into either the acupuncture group or placebo control group. There was a significant reduction in random blood glucose level in the acupuncture group compared to baseline. No such significant change was observed in the placebo control group. The result of this study suggests that 30 minutes of needling at CV-12 might be useful in reducing blood glucose level in patients with type 2 diabetes mellitus. (Kumar et al 2017)
  • Here, a case of type 2 diabetes mellitus in a patient with Myasthenia gravis who underwent 105 sessions of acupuncture delivered over 6 months is reported. After acupuncture treatment, the patient’s fasting plasma glucose and hemoglobin A1c levels, as well as the score on the Hamilton Depression Rating Scale, were decreased. Furthermore, no adverse effects were observed. The findings in this clinical study are encouraging and provide evidence supporting the effectiveness of acupuncture in reducing type 2 diabetes mellitus in a patient with MG. (Kim Y 2017)
  • According to a review by Hui which appeared in the Journal of Traditional Chinese Medicine 1995; 15: 145-154 animal experiments have shown that acupuncture can activate glucose-6-phosphatase (an important enzyme in carbohydrate metabolism) and affect the hypothalamus.  Acupuncture can act on the pancreas to enhance insulin synthesis, increase the number of receptors on target cells and accelerate the utilization of glucose, resulting in the lowering of blood sugar.
  • According to a study reported by Chen et al in the Journal of Traditional Chinese Medicine 1994 14(3): 163-166 they found that by using acupuncture for diabetes nearly 2/3 of the patients receiving acupuncture showed marked improvement.  Furthermore the patients receiving acupuncture experienced a statistically significant decline in cholesterol, triglycerides and beta-lipoproteins. The drop in triglycerides was most substantial with a decline from an average value of 151 at the start to 117 one month later.
  • A study published in Diabetes Res Clin Pract 1998 Feb;39(2):115-21 on 46 patients with chronic painful peripheral neuropathy concluded that acupuncture is a safe and effective therapy for the long-term management of painful diabetic neuropathy, although its mechanism of action remains speculative.
  • Another study published in Russian in the journal Probl Endokrinol (Mosk) 1991 Jul-Aug,37(4)-20-3 on diabetic angiopathy of the lower extremities on 55 patients with insulin-dependent diabetes mellitus showed a direct noticeable clinical effect with acupuncture In 78.2% of cases, determined perhaps by improved elastotonic properties of arteries of average caliber, enhanced blood outflow and regulation of lower limb vascular peripheral resistance.

Blood Markers in Insulin Resistance and Diabetes

C-reactive protein – In this study, C-reactive protein (CRP), interleukin 6 (IL6), and tumor necrosis factor alpha (TNF-α) associated with type 2 diabetes mellitus (T2DM). Our findings suggested that these inflammatory markers, especially C-reactive protein, may initiate type 2 diabetes mellitus (Phosat et al 2017)

Folate status is typically reduced in diabetic patients. (Pusparajah et al 2016)

HbA1c – Type 2 diabetes mellitus (T2DM) is a risk factor for cardiovascular disease (CVD), and T2DM patients are at increased risk of morbidity and mortality from CVD. The presence of T2DM also increases the relative risk (RR) of developing CVD in women (RR = 8.5) compared to men (RR = 3.2). Major CVD risk factors that have been identified in type 2 diabetes mellitus patients include arterial stiffening, endothelial dysfunction, hyperglycemia, and elevated glycated haemoglobin (HbA1c) concentrations. (Vijayakumar et al 2017)

HbA1c – In type 2 diabetics, recently, elevated HbA1c level has also been considered as one of the leading risk factors for developing microvascular and macrovascular complications. Improvement in the elevated HbA1c level can be achieved through diet management; thus, the patients could be prevented from developing the diabetes complications. (Sami et al 2017)

HbA1c – There is no argument that improving mean level of glycemic control, assessed by glycated hemoglobin (HbA1c), reduces the risk of microvascular complications and cardiovascular disease (CVD) events in patients with type 2 diabetes. Chronic sustained hyperglycemia has been shown to exert deleterious effects on the β cells and the vascular endothelium. (Huang et al 2017)

Homocysteine – High levels of homocysteine (Hcys) have been identified as a risk factor for CVD in type 2 diabetes mellitus (T2DM) patients. High concentrations of Hcys are associated with increased low-density lipoprotein oxidation and endothelial dysfunction. High concentrations of Hcys can worsen T2DM by inducing reversible dysfunction of β-islet cells and inhibiting secretion of insulin. (Vijayakumar et al 2017)

Vitamin B12 and folic acid – Several other studies also reported a statistically significant increase in the total plasma level of homocysteine and a statistically significant decrease in the serum levels of vitamin B12 and folic acid in diabetic retinopathy. (Srivastav et al 2016)

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